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  • Title: Education and counseling for Norplant users.
    Author: Hinkle LT.
    Journal: J Obstet Gynecol Neonatal Nurs; 1994 Jun; 23(5):387-91. PubMed ID: 8083779.
    Abstract:
    Because Norplant provides effective contraception for 5 years, it is an excellent choice for many women. However, it has side effects that have prompted early removal in a significant number of women. Nurses who educate and counsel women about Norplant before insertion and provide support and management of side effects afterward can increase user satisfaction and long-term continuation. The subdermal implant system Norplant delivers a continuous low dose of levonorgestrel to bring about effective, reversible contraception for 5 years. International studies show that 1st, 2nd, 3rd, 4th, and 5th year failure rates are 0.2%, 0.2%, 0.9%, 0.5%, and 1.1%, respectively. Norplant becomes effective 24 hours after insertion. It should be inserted within the 1st 7 days of the menstrual cycle. The US Food and Drug Administration approved Norplant in December 1990. Norplant's most common side effect is menstrual disturbances, including irregular bleeding, prolonged bleeding, spotting, and amenorrhea. They are also the most common reasons for discontinuation. The discontinuation rate after 1 year for US women is 10%, which is lower than discontinuation rates for oral contraceptives and the IUD. The Norplant system costs $365, which does not include the cost for insertion. The cost of removal tends to be over $100. Counseling before insertion and support and management of side effects after insertion increase user satisfaction and tolerance of side effects. Nurses should make sure that they are giving women complete, unbiased information, which is not influenced by the nurses' personal values, about the disadvantages and advantage of Norplant. They should present Norplant as 1 of many contraceptive choices. They should present the information at the level appropriate for the age, education, and language of the client. The information should include how Norplant prevents pregnancy, efficacy and failure rates, recommended time of insertion and how soon it becomes effective, description of the insertion and removal procedures, risks, contraindications, potential side effects, danger signs, and length of effectiveness. Contraindications to Norplant are acute liver disease or liver tumors, undiagnosed vaginal bleeding, history of thromboembolism, breast cancer, and pregnancy. Nurses can provide postinsertion support by phone or clinic visit. They can also help manage side effects.
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